Doctor insights on:
Long Term Use Of Gabapentin For Relief Of Peripheral Neuropathy

1

Gabapentin:
In general, Gabapentin is well tolerated and used safely long term. But as with any other medications, it has potential side effects such as mood disturbances, dizziness, fatigue, leg swelling, low white cell count, low platelet count, and renal failure. In rats, pancreatic cancer is reported. It should be used with caution in chronic kidney disease and should not be stopped suddenly.
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A complete nerve transection will leave an area totally numb. The distribution of the numbers depends upon where the nerve was cut. A partial nerve injury may leave the area tingly or incompletely numb. Finally even if the nerve is not cut the swelling and bruising to the tea can affect the nerve as well. Usually we consider sharp penetrating injuries as likely having nerve lacerations when sensation is lost. A hand surgeon can examine the hand and pinpoint the site or extent of nerve injury and recommend surgical repair if needed.
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2

Not major problem:
Many choices including Lyrica (which may be tolerated better than gabapentin, but also consider Horizant and Gralise). Might try Cymbalta, Savella, (milnacipran) amitryptyline, but may benefit from lamotrigine, levetiracetam, other tricyclics or even SSNRI's. But maybe find etiology of neuropathy and treat cause directly.
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5

Neurontin (gabapentin) dosage:
It varies depending on individual conditions and response to medication. It is difficult for say in your conditions. For most of my patients, they are taking 600-800mg three times daily for peripheral neuropathy.
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6

Increase Gabapentin?:
Gabapentin (g) toxicity in patients with chronic kidney disease (ckd) is under recognized. Patients with CKD often receive inappropriately high g dosage for their kidney function, occasioning overt toxicity; advanced age and comorbidity predispose CKD patients to toxicity. I would ask your nephrologist's (c) opinion before increasing the dose, as the n knows you the best.
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Go to your PCP:
It would be best to start one medication at a time to see your response. Every individual response to Cymbalta (duloxetine) is different but you can start at 30 mg. Once you've established the dose for Cymbalta (duloxetine) and your neuropathy is still troublesome, you can add Gabapentin. It is best to have your doctor monitor your medication.
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Different treatments:
Peripheral neuropathy is when the nerves do not function as they should when the sensory nerves are affected, the sensations can range from complete lack of sensation to a "lightning bolt" pain that occurs sporadically. Both of these medications are used to treat peripheral neuropathy as well as several others. Not all medications work for everybody so use it for a while to be sure.
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Dilantin:
The use of Dilantin is unlikely to reduce the pain of peripheral neuropathy if the other anti-convulsant medications have failed to relieve the pain. Alternative treatments such as transcutaneous electrical nerve stimulation, capsaicin cream, Lidocaine patches and identifying and treating the cause of the neuropathy may help you feel better.
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Peripheral Neuropath:
Different possibilities exist for leg pains: neuropathy, vascular disease, and sciatica. Each of these can be ruled in/out based upon history, examination, and studies. Neuropathy is typically diagnosed with history of diabetes, chemo, toxic exposures, or no cause, and is associated with numbness/pain in a stocking distribution with absent reflexes. Emg/ncv can be helpful. Mri/ct usually negative.
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14

It can be:
Sensorimotor peripheral neuropathies have many types and various causes. Some of them can be disabling, even long term in some cases. A thorough search will have to include blood tests and urine tests. In some cases spinal tab (lumbar puncture) can be necessary. In delineating the diagnosis.
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18

Depends on the cause:
It depends on the cause of your peripheral neuropathy (diabetes, hereditary condition, nerve impingement, stroke, prior surgeries). A neurologist would be best served to give you an educated answer based on nerve testing.
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19

Peripheral Neuropath:
It depends on how the myelin was injured. If myelin was severed/ traumatized axon only damage neuron will grow ideal conditions 1mm / monthInstead if disease process responsible for myelin damage (autoimmune disease i.e. MS, ALS,) this damage is permanent myelin sheath will not grow back damage is permanent. Peripheral diabetic Neuropathy if addressed before perm damag meylin can regenerate
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21

Sounds like:
You would benefit from a personalized virtual consult on Health Tap. This forum is best used for more generalized questions. A physician will need to know more about your symptoms and their timing, but can certainly provide helpful advice.
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22

See details:
Avoid taking narcotics at all if possible. The addiction risks increase the longer you take it. Instead, increase the Lyrica (pregabalin) dose. I am not sure Baclifen has all that much benefit. Finally, identify and treat the cause of the neuropathy.
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23

Treat the cause:
The best way to 'cure' neuropathy is to target the cause. Only 60-70% of patients with neuropathy have a known cause, any many are irreversible. However, controlling the underlying medical condition causing neuropathy can improve or delay the progression of neuropathy. For example: control diabetes, treat thyroid problems, treat rheumatoid arthritis, avoid alcohol, take a b complex vitamin.
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24

Possibly:
Even though Lenalidomide causes less neuropathy it still occurs. Also depends on the disease. Meaning how aggressive does one need to be. Is there kidney dysfunction? Is the patient of transplant age?
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26

PN & RLS Rx:
Neurontin (gabapentin) is used to treat both those conditions. It is possible that you have both, but be careful. The symptoms overlap. There are special symptoms for RLS that PN does not have- such as it improves with walking. People with RLS often have a low ferritin level, and such cases improve with iron therapy.
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29

Herbs can treat but:
Are you asking if herbs may cause peripheral neuropathy? It is usually caused by diabetes, side effects of pharmaceuticals & toxins like heavy metals. Some chinese & ayurvedic herbs are contaminated with heavy metals so those could be a cause. However, many herbs have been shown to be helpful in treating neuropathy. See www. Caring. Com/articles/peripheral-neuropathy-treating-it-the-natural-way.
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Also called neurontin, (gabapentin) is an anticonvulsant medication used to treat seizure, also for post-herpetic neuralgia & other neuropathic pains, as well as restless leg syndrome. It works by lowering excitation of brain through gaba.
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